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Differentiating nursing grand and middle range theories

A theory is a group of concepts that relate to one another and proposes actions to be used. Nursing theories have serve as a guide to nursing practice, and have help build the foundation for nursing as a discipline. Some of the theories used in nursing practice can be divided into grand theory and middle range theory.

According to DeNisco and Baker (2016), grand theories or conceptual models, are broad in scope, abstract in description and can be tested. They are composed of related concepts that aren’t concrete but can be used throughout the different fields of nursing. In contrast, middle range theories are less abstract than grand theories, have less concepts and propositions and can be tested directly. Middle range theories are more concrete and are directed to specific nursing situations, making it easier to form nursing interventions and predict patient outcomes (DeNisco & Baker, 2016, p. 398).

An example of grand theory or conceptual model is Virginia Henderson’s Need Theory. Henderson’s Need Theory highlights the importance of individual care while promoting and encouraging patient’s independence. It also underlines the importance of basic human needs such as performing activities of daily living, maintaining cleanliness, adequate sleep and rest so that post hospitalization progress would not be hindered.

Furthermore, Henderson’s theory is used to describe the role of the nurse as substitutive, doing something for the patient; supplementary, helping the patient do something and complementary, working with the patient to do something. In research, Henderson’s findings indicated that nursing research studied nurses as opposed to studying nursing care.

In addition, Henderson wrote for professional journals to help reorient nursing research to become more clinical.  Henderson’s most challenging contribution to nursing research was a research project she put together cross referencing every piece of research on nursing published in English titled Nursing: Research Survey and Assessment .

An example of middle range theory is Ida Jean Orlando’s Nursing Process Discipline Theory. Orlando’s theory looked at the dynamic relationship between the nurse and patient. She explained the role of the nurse is to find and meet the patient’s immediate need. Orlando also described her theory in five interconnected concepts.

These concepts are the functions of the nursing profession, the patients presenting behavior, immediate reaction as the nurse’s internal response, the nursing process discipline which is finding the patient’s needs and lastly, improvement, which is resolving the patient’s problem.

In respect to nursing research, Orlando used her own research findings to develop her theory. Orlando’s theory have helped shape nursing today. Her five stages of the nursing process, assessment, diagnosis, planning, implementation, and evaluation has contributed to nursing research today and has help produce positive outcomes and patient improvement.

1 thought on “Differentiating nursing grand and middle range theories

Ziggy April 1, 2019 at 2:18 pm

Both nursing grand and middle range theories complement each other when it comes to
promoting nursing practice. The author of this post argues that despite the eminent contrast in the
two models, they both have the same goal of providing support and guidance to nurses, both
practicing and preparing. The post clearly outlines the functions of the two theories in terms of
application; nursing grand theories are complex and are made up of nonconcrete concepts while
middle range theories are less tangible and can be used for empirical testing. Unlike nursing
grand theories, middle range theories are more specific to the nursing practice
In the past years, several nursing theories have been developed to guide the nursing practice
.The author in this case consecutively presents Virginia Henderson’s Need Theory and Ida Jean Orlando’s Nursing Process Discipline Theory as examples of grand and middle range theories that have greatly contributed to the development of nursing as a profession. The post complements Henderson’s Need Theory in the way it is used to guide the need for personalized care and to encourage and promote the independence of patients. On the other hand, Orlando’s Nursing Process Discipline Theory advocates for positive patient outcomes through its advocacy on improved nurse-patient relationship.


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